Claims Specialist

Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Company Job Description/Essential Functions:

Review and process provider dispute resolutions according to state and federally defined timeframes.

Research issues; adjust claims, including computation of interest owed as appropriate.

Send written responses to providers in a professional manner within required timelines.

Forward cases to the IRE or the DMHC as needed.

Answer provider inquiries regarding disputes that have been submitted.

Maintain and track disputes through HPSM’s grievance and appeals database.

Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed.